Southwestern Vermont Health Care (SVHC) and five private physician practices serving a rural area propose to reduce medical errors and adverse events through the implementation of an integrated electronic health record. The comprehensive record will be accessible at all participating care delivery sites and to the patient/resident from home. This will include implementation of an electronic patient medical record, electronic medication administration record, computerized physician order entry, and clinical decision support software in physician practices, the medical center, a home health agency and a long-term care facility. SVHC will institute a new Safety Division under the leadership of the project director, who will serve as Chief Medical Safety Officer. By project end it is expected that all partners will use common access to an EHR to ensure high quality care. Key barriers are the cultural changes required for a proactive rather than reactive safety culture, and alignment of goals across and within providers regarding technology implementation. The project goals are: 1) SVHC will demonstrate an increased culture of safety that encourages and supports the reporting of errors and adverse events, near misses and good catches, and feed information back to improve systems safety; 2) Physicians and other health care providers will use a secure, confidential, integrated electronic health record that is accessible from any location and includes all episodes of care from all locations of care among grant partners; and 3) Improve patient safety and quality of care for patients served by partners. A summative evaluation will report on attainment of each of the outcomes listed in the goals and objectives. A formative evaluation will record changes in the safety climate, effectiveness of the e-MAR system; and the framing of key issues among the partners over time. The proposed safety and EHR project is part of a much larger strategic plan at SVHC to implement a wide range of IT tools throughout the health care system. [unreadable] [unreadable]